Basic Studies on Locational Planning of Emergency Medical Facilities, Considering Patients' Accessibility to a Facility

1.这些天来，改善紧急医疗服务的需求一直在增加，特别是在熊本这样的省级地区。本研究以熊本为个案，旨在检视急救医疗设施选址规划所需的技术与基本考量：(1)网络分析技术，以病人对设施的可达性作为服务水平的替代；(2)急救医疗服务需求的定性与定量概况；(3)一些有效改善服务的政策。我们进行了两种不同类型的调查：一是调查了熊本县两大急救医疗机构的12000多名患者的概况；二是选择特定的一周，调查了熊本市医疗机构紧急医疗服务的患者数量。在建立熊本县主要公路网数据库和人口感知库的基础上，开发了一个规划支持系统，该系统可用于分析县内各小区域设施的可达性，进而寻找设施的最佳选址。该系统显示，该县南部地区的紧急医疗服务水平较低，选址新设施是不可避免的。研究的其他结果是：我们评估了改进的位置优化求解技术的效率：我们提供了各种数据，表明夜间对初级医疗服务的需求很大，这些需求往往会扰乱真正情况严重的患者的紧急医疗服务：我们提出了“患者筛查系统”来缓解上述问题。我们做了一份总结报告，其中收集了所有已经发表的论文。

1. Demands for improving emergency medical services have been increasing in these days, especially in a provincial area like Kumamoto. Selecting Kumamoto as the case, this research project aimed at examining techniques and basic considerations required for a locational planning of emergency medical facilities: (1) techniques of network analysis to find optimal location of such facilities, using accessibility of patients to facilities as a surrogate for a level of services: (2) both qualitative and quantitative profile of demands for emergency medical services: (3) some of polices effective to improve those services.2. We made surveys of two different types: firstly, we surveyed profiles of more than 12000 patients visited two major facilities of emergency medical servicies in the Kumamoto prefecture: secondly, selecting a specific week we surveyed number of patients visited medical facilities in the Kumamot City for emergency medical services.3. Building major road network data-base and population sensus data-base for the Kumamoto prefecture, we developed a planning support system which can be used firstly to analyze accesibility to and from the facilities for every small zone of the prefecture, and secondly to find optimal location of facilities. The system showed that a level of emergency medical services is low in southern part of the prefecture and that locating a new facilitiy is inevitable.4. Other results of the study are: we assessed an effciency of the improved solution technique of locational optimization: we presented various data which show that there are substantial amoutn of demands for primaly medical care in tha night time and that those demands tend to disturb emergency medical services for patients who are in a really serious condition: we proposed a "patient screening system" in order to ease such problem as described above.5. We made a summary report, in which all papers already published are collected.